Know Your Numbers

How are Your Lipids?

Most of us know to watch our cholesterol levels. But what does that mean, really?

HDL, LDL, triglycerides – which is the “bad” one; which the “good?” How do I get them in the proper balance?

MyLifeStages talked with Dr. Jane Lombard, a cardiologist with the Palo Alto Medical Foundation’s Mountain View office, to get an update on this important topic.

Who should be concerned about cholesterol?

Dr. Lombard's first piece of advice is to know your own health risk factors. "No two patients are alike," notes Dr. Lombard. "It's important to know your own risks for heart disease or any other condition."

Coronary artery disease (CAD) can take your life – suddenly, without warning, through a heart attack or a stroke. Yet there are things you can do to prevent that from happening. The first step is to have a detailed discussion with parents and siblings about your family health history.

You are more at risk for CAD if:

You have a family history of heart disease, particularly if it was diagnosed in a male relative under age 60, or a female relative under age 70.

You are overweight.

You exercise very little, or not at all.

You have diabetes.

You have high blood pressure.

You are a woman post menopause.

If you don’t have any of these risk factors, it is still recommended that you have a blood test to measure your cholesterol levels (called a lipid panel) by age 50, if you haven’t started screening before then.

If you have one or more of the risk factors above, talk with your doctor about when you should start being screened, and how often.

What do the lipid numbers tell you?

Your lipid panel will probably give you four numbers:

Total CholesterolThe ideal is less than 200.

High Density Lipoprotein or HDLThe ideal is more (higher) than 50 mg/dl for women and 40 mg/dl for men.

Low Density Lipoprotein or LDLThe ideal is less than 130 mg/dl for the general public.

TriglyceridesThe ideal is less than 150.

These measurements are given in “milligrams per deciliter of blood, or mg/dL)

If your numbers are good, congratulations! If one or more are out of whack, here’s more to know:

Total cholesterol measures both HDL, Triglycerides and LDL circulating in the blood. It’s a good starting point to know if you have “high cholesterol,” but doesn’t tell the whole story, according to Dr. Lombard. “It’s important to look at each parameter separately.” To see all parameters, you should have a fasting blood test, called a lipid panel, rather than just a finger-stick blood test.

The measurement of LDL is an important one, says Dr. Lombard. “For most patients, LDL should be below 130. For patients who have risk factors, or have already been diagnosed with CAD, it’s important to lower LDL even further – to 100 or less. Under 70 is the new target for most patients with known coronary artery disease.”

HDL is the “good” cholesterol measurement, given that it represents your ability to carry unwanted cholesterol out of your body. But even a high HDL number isn’t as important, says Dr. Lombard, as a low LDL number.

Triglycerides measure an amount of circulating fats in your blood. Triglycerides aren’t necessarily related to eating too much fat – they are, in fact, sensitive to the amount of simple carbohydrates in your diet. If you consume more of these simple carbs and sugars than your body is using, they must be stored. Conversion to triglycerides is a first step. For that reason, this measurement in very volatile and subject to fluctuations, given what you may have recently consumed. “If you have enjoyed a big bowl of ice cream the night before your blood test, your Triglycerides will likely be elevated,” says Dr. Lombard.

“Triglycerides are being looked at more carefully,” she continues. “This measurement is being linked more closely to heart disease, especially for women.”

So, what do you do, if your numbers are too high?

Healthy Without Drugs

“My first advice is always the lowest risk and least expensive,” says Dr. Lombard. “I suggest patients exercise more and lose weight.” She notes that exercise, good nutrition and weight loss address not only CAD, but a host of other health conditions – from diabetes to bone strength; from cancer prevention to improvement in mood. Not bad for an all-purpose health enhancer.

The prescription for exercise, according to Dr. Lombard, should be 30 minutes a day, minimum. “Minimum,” she stresses. “I see more and more women who are active into middle-age,” says Dr. Lombard. “That is so encouraging. Women in previous generations just stopped moving. Not today’s women.”

When Drug Are the Answer

For some patients, exercise and nutrition just don’t improve the numbers enough. Statin drugs, then, can really make a difference. They should be prescribed, however, only for those whose particular risk factors and/or lipid measurements warrant the drug. “For the right population, statins are a wonderful tool,” notes Dr. Lombard.

Other medications that can benefit those with high triglycerides include Niacin. Omega 3 oils, and fiber. However, the right combination of drugs, both prescription and over the counter, depends on the way your own numbers look. So consult with your physician for the best plan for your unique needs.

Dr. Lombard also strongly suggests that you talk with your doctor about all medications, and supplements, that you might be taking. “These ‘nutraceuticals’ – even if bought at the grocery store, can interact with your prescription drugs. Most are not regulated, so their potency can vary greatly. Let your health care provider help you design the right combination of medications to specifically target yours needs,” she adds.